Introducing the General Healthcare System (GHS), the biggest shake-up in the history of Cyprus health, is heading for a crash as doctors and nurses refuse to join the new scheme.
Health worker unions and doctors’ associations have told their members not to sign contracts offered to them by the State Health Services Organisation OKYPY, expressing their strong disagreement with those individual contracts on offer.
Doctors and nurses have described these contracts as incomplete, vague and disappointing, stressing that they were not given enough time to evaluate them as they were given 10 days to give their answer after receiving them just before Christmas.
Therefore, OKYPY has postponed the date of the official offer of contracts to each employee, which was initially set for January 7.
A round of discussions has kicked off between the government and the other parties, with focus on the doctors, with the Health Insurance Organisation, the authority set up by the government to oversee the implementation of the GHS, confident that the scheme will take-off without any hitches.
President Nicos Anastasiades has personally stepped in to hold two meetings with the Cyprus Medical Association (PIS) this week with the two sides still far apart. Despite reports that the government has accepted most of the doctors’ demands, the association claims that they are far from reaching a mutual understanding.
After doctor’s refusal to participate in the GHS, Anastasiades said on Friday: “I would like to believe that the overwhelming majority of physicians, after the dialogue that we have started, will decide to participate in the GHS.”
“I believe that the overwhelming majority of doctors place above all else their Hippocratic oath, as well as their social sensitivity and contribution that distinguishes the medical world of Cyprus”.
Doctors fear that they will be overloaded with work, and while they will be joining the GHS as self-employed contractors, at the end of the day they will be treated as employees of OKYPY, the authority overseeing the management of autonomous health institutions. They also argue the GHS budget falls short of what is required.
“The contracts handed to us contain all the obligations of a public servant but not the benefits of one,” said paediatrician Dr Anastasia Symeou, secretary of PIS.
She argued that doctors signing a contract with OKYPY will not be entitled to practice privately and will not be allowed to receive payments from private insurance companies. PIS insists that doctors be given the right to freely practice private medical care in a GHS environment, something rejected by the Health Ministry.
Symeou said this is not something that endangers the philosophy of the health scheme nor will it require a change in the legislation.
At the same time, the Medical Association insists on a long-term guarantee of the unit price per medical practice for specialist doctors.
Symeou said doctors are also concerned about the budget, despite the government’s commitment to financially support the public health care system if it comes under pressure.
“The Health Insurance Organisation is not truthful in trying to convince the public that the GHS will offer the same conditions found in private medicine. This cannot be done, it is impossible. We know that doctors will have a very large number of visits and the personal GP will be forced to see too many patients daily. You cannot set a limit on the number of times a patient is allowed to see their GP,” said Symeou.
She added that the Cyprus Medical Association believes that the HIO has got things wrong regarding its budget plans.
“The medical world is called upon to take on that risk. From the moment that doctors were excluded from the design process of the GHS they should not be asked to take the risk”.
On what happens next, Symeou said: “We will give colleagues all the information. If the HIO goes knocking on the door of each doctor individually, he or she will decide whether or not to join the system. As far as the 260 paediatricians working in Cyprus their position is clear. We are negative towards joining the scheme as it stands today”.
The union of State Doctors (PASIKI) rejects signing any individual contracts and is calling on OKYPY to adopt collective agreements with health workers. Nurses’ unions have also called on their members not to sign the proposed contracts.
Nurses worried about pay
State nurse’s union PASYNO has also urged their members not to sign contracts given to them as they feel that they are vague with some clauses eliminating benefits they have in the current public healthcare system.
Theodoros Petelis, PASYNO’s president told the Financial Mirror, that the contracts offered cannot be considered attractive for nurses, especially those already employed in the public health system.
“Wages are not clear, holidays are less than what they currently are. Contracts offered by OKYPY foresee wage increases every three years, while nurses in the public health sector see an increase every year,” said Petelis.
He said that contracts offered do not include clarifications as to what other benefits the nurses will be entitled to.
“We do not know if we will be entitled to night shift allowances and whether we will be paid for any overtime put in or how much that will be.”
Furthermore, Petelis said the evaluation process of staff employed by the OKYPY has not been explained.
He added that one of the nurses’ demands was that the introduction of ‘healthcare assistants’ to the hospitals.
“A healthcare assistant will be a person who will take care of tasks not assigned to nurses but currently carried out by them. Such as transporting patients from one department to another or taking care of patient’s personal hygiene. This will help relieve the problem of understaffed hospitals,” said Petelis.
“These are all matters that could have been solved if the authorities had cared to talk them over with the parties involved. However, we were not given the chance to form and articulate our views in negotiations with them.”
PASYNO’s head wants all issues to be addressed before the launch of the GHS or it “will not be the GHS people deserve” noting that hospitals and doctors don’t seem to be on board either.
Authorities set up to finance and manage a universal healthcare system do not seem concerned about the difficulties the GHS may face when it launches on June 1, 2018.
Angelos Tropis, head of the Health Insurance Organisation, is not concerned over statements and moves made by the unions as he is confident that come June, they will have enough doctors and health institutions on board.
Tropis said the GHS is better as it removes the work overload on public health care. “So, doctors should not be concerned that they will be overloaded with work,” he said.
He added that with the GHS, doctors will be given the incentives to increase their productivity and will in no way lose out on salaries or benefits previously enjoyed by health workers. He said the HIO is in continuous negotiations with the various health workers regarding their pay and conditions.
He said that health workers should not be worried over the budget of the GHS as the budget approved for the GHS is EUR 1 bln, the same amount approved last year for the public health sector. He added that contributions will also start coming in as of March, so financing problems are not expected.
Doctors argue that the budget allocated to the GHS should be equal to 10% of the country’s GDP and not the current 7%.
“Doctors are asking for an increase in the budget, but they are not telling us where they want the additional money to go to,” said Tropis.